Do I Have Social Anxiety Disorder?

If you’ve ever had to speak or perform in front of a large group of people, you know that the experience can be anxiety-inducing. You might worry about tripping as you step up to a podium or walk across a stage, forgetting parts of your speech, not performing as well as your competition, or not getting applause from your audience. Maybe as you anticipate the event, your heart rate increases, you sweat more than usual, or you have butterflies in your stomach. Many people call this stage fright or performance anxiety, and it’s pretty standard, sometimes even for those who regularly have to address or entertain crowds.

For some people, though, the idea of speaking in front of others is terrifying. Instead of nervousness and a racing heart, these individuals experience full-blown panic attacks just thinking about being the focus of others’ attention. Their discomfort and intense anxiety extend to everyday social situations like being called on in class by a teacher, attending an office meeting, or even talking to others in an elevator. They worry about others’ judgment of them or potential rejection, so they try to avoid social interactions altogether. This excessive fear of social situations is a real and common mental health condition called social anxiety disorder, also known as social phobia.

Defining Social Anxiety Disorder

The fifth edition of the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines social anxiety disorder as “persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing or humiliating).”

The word “persistent” is key to this definition. Occasional feelings of anxiety in certain social situations or shyness around new people can happen to almost anyone. However, someone with social anxiety disorder will experience this extreme fear, anxiety, dread, or avoidance consistently for six months or more. 

Other factors set social phobia apart from rational concerns or fears of social situations or public speaking. People suffering from social anxiety understand and recognize that their fears are excessive or unreasonable, but they can’t do anything to lessen them. Also, their social anxiety symptoms disrupt their daily lives. According to the DSM definition, “the avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly” with the daily routines, school work, occupations, social activities, friendships, and overall quality of life. Lastly, to be classified as social anxiety disorder, symptoms can’t be explained by the side effects of prescription medications or substance abuse.

Social phobia is a lot like other phobias, such as intense fears of spiders, snakes, or heights. People with a specific phobia like these will have similar reactions as those with social phobia. In this case, though, the feared object isn’t an object, but a specific situation.

Who suffers from social phobia?

Social phobia is the second most common type of anxiety disorder in the United States. It affects about 15 million people or about seven percent of the U.S. population. And it doesn’t discriminate based on gender.

This type of anxiety can begin in adolescence, although a specific situation can trigger onset in older adults. Social anxiety disorder is usually diagnosed during the teenage years. Children with social phobia will exhibit symptoms (including tantrums or crying), which are different than those experienced in adulthood.

According to the National Institute of Mental Health (NIMH), there are several possible causes of social anxiety disorder, although there’s not yet scientific evidence for any of these. Recent research has found that the condition can run in families, but not necessarily due to genetic factors. Instead, research studies suggest children or family members of social anxiety disorder sufferers are more likely to develop symptoms as learned behaviors or as a result of overprotective or hypercritical caregivers.

Some researchers also believe that cultural influences, environmental factors, and social experiences can also contribute to the development of social anxiety disorder. For example, limited opportunities to interact with others in social situations and develop acceptable behaviors and expected social skills as an adolescent may lead to social anxiety. Likewise, a particularly humiliating or traumatic event in a social situation, such as being bullied by a group of classmates or making a major faux pas during a public presentation, may also contribute to social anxiety.

There’s also some evidence that this anxiety disorder could be due to an imbalance in brain chemistry or a hyperactive amygdala, which is the area of the brain associated with fear and negative emotional processing.

Could you have a social anxiety disorder?

With so many potential risk factors contributing to the development or onset of social anxiety, it’s difficult to determine if you’re at high risk for this condition. It’s even hard to know if you’re currently suffering from social anxiety disorder. The Social Anxiety Institute calls social phobia the “least understood” anxiety disorder and mental health care problem. According to the Institute, the “vast majority of people with social anxiety do not know that they have it,” although they know something is “wrong” with them.

Social anxiety presents itself in both physical symptoms and psychological fears. The physical symptoms of social anxiety may include blushing, difficulty talking or stumbling over words, avoiding eye contact, nausea, profuse sweating, trembling, restlessness, rapid heartbeat or palpitations, or shortness of breath. These are all a result of the fight-or-flight response, a physiological reaction to a perceived potential threat or attack. For individuals with social anxiety, the social fears of rejection, judgment, or doing something embarrassing or wrong is so extreme that it feels like mortal danger and the stuff of nightmares.

For people with social anxiety disorder, fear can be a response to almost any kind of social setting or instance, including:

• Going on a job interview
• Writing in front of a class
• Speaking on the phone in a group format
• Using public restrooms
• Placing an order in a restaurant
• Going on a date
• Attending a party
• Being called on in a classroom or meeting
• Meeting new people
• Undergoing a medical examination
• Being in the presence of a person of authority
• Being in public

Other Symptoms of Social Anxiety Disorder

This fear of social situations will cause a great deal of anticipatory dread leading up to the event. Many individuals with social anxiety will try to avoid these instances altogether. However, if they are forced into an anxiety-inducing social setting or are caught in a difficult situation without warning, their anxiety response could be severe, perhaps even provoking a panic attack or, more accurately, an anxiety attack.

Interestingly, The Social Anxiety Institute disagrees with the “panic attack” language used in the DSM-5 description of social anxiety disorder. The institute clarifies that while panic attacks usually “precipitate feelings of a medical emergency” (like chest pain before a heart attack) and are a separate type of anxiety disorder, an anxiety attack is triggered when a person fears something terrible is going to happen.

What Social Anxiety Is Not

With this lack of clarity within definitions as well as sufferers not clearly understanding that their anxiety symptoms may indicate social anxiety disorder, it’s not surprising that physicians and mental health professionals often misdiagnose the condition.

The Social Anxiety Institute reports working with socially anxious patients who have been misdiagnosed as having clinical depression, major depressive disorder, bipolar disorder, panic disorder, schizophrenia, personality disorder, attention-deficit hyperactivity disorder (ADHD), and Autism Spectrum Disorder.

Some of this confusion may be due to the “newness” of social anxiety as a mental disorder. Shyness has been described in literature since around 400 B.C. However, the terms “social phobia” and “social neurosis” weren’t used until the early 1900s to describe the psychiatric disorder of extreme shyness. Even then, this mental disorder wasn’t fully recognized by the medical community until 1985, when it was included in the third edition of the DSM. The description was revised in 1989 to include “avoidant personality disorder” and “generalized social phobia.”

It’s Time to Find Professional Help

With its severe impact on a person’s daily life, social anxiety disorder can be debilitating. However, there are excellent treatment options to help you manage or overcome anxiety disorder. You may choose to make an appointment with your general practitioner to rule out any medical conditions or side effects from medications that may be causing your symptoms.

If a general practitioner suspects a diagnosis of an anxiety disorder, they may refer you to a psychiatrist or psychologist for treatment. With all medical or mental health professionals, be sure to describe your anxiety symptoms in detail, including when and where they present themselves and exactly how you react. This communication will help to ensure an accurate diagnosis of social phobia rather than a related anxiety disorder, mood disorder, or one of many other common mental disorders.

Treatment of social anxiety may include medication, psychotherapy, or, most likely, a combination of both. Three types of medications are often prescribed to treat symptoms of social anxiety disorder: anti-anxiety medications, antidepressants, and beta-blockers. While anti-anxiety medications and antidepressants treat the physiological symptoms of this specific type of anxiety disorder, beta-blockers primarily work on some of the physical symptoms, such as increased heart rate, tremors, or excessive sweating. Your doctor will carefully craft the right combination of medication doses and length of treatment to minimize side effects and ensure you don’t develop a dependency.

Psychotherapy, also known as talk therapy, complements medication treatment. There are several types of psychotherapy options available for the treatment of social anxiety disorder, and cognitive-behavioral therapy (CBT) has proven to be one of the most effective. CBT works by retraining your brain to think, behave, and react differently to the situations that make you feel anxious or afraid. Your therapist will use techniques like repetition and reinforcement during your CBT treatment, helping you to recognize and better cope with your negative thoughts and irrational fears. A good therapist can also help you with social skills training.

Find a Mental Health Professional Today

Social anxiety disorder is a severe mental health condition that can keep you from developing a social life and enjoying everyday situations. The mental health professionals at Therapy Group of NYC can help you discover or get back to your own kind of normal, so you can enjoy life again. Don’t wait to reach out to one of the best therapists in New York City today.